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Pharmacy Data Management

ImageIntegrated Pharmacy Solutions, Inc. (IPS) pharmacy data management services and network solutions are among the most comprehensive in the industry. Our data management expertise and experience stem from a wide variety of managed care and government sponsored pharmacy claim processing specials projects.

The data management and audit staff at IPS is uniquely qualified to manage and review all aspects of prescription drug benefits, provider performance as well as contract management and regulatory affairs compliance. IPS has been qualified as a CMS Medicare auditor and has participated in an advisory group to formulate the CMS audit recommendations.

IPS pharmacy claims auditors are experienced pharmacists and certified pharmacy technicians each fully trained and skilled to identify inappropriate, potentially fraudulent and deficient billing practices. Many of our data management and audit service projects have been customized to meet our client’s needs. Additionally, IPS audit and data management tools can be utilized to complement one another to serve an educational role. Along these structured lines, IPS can validate that it’s service renderings can be tailored to meet or exceed clients directives to both assess and facilitate optimum behavior modification and provider quality assurance opposed to solely financial sanctions. Examples of successful data management special projects include:

  • Network Pharmacy claims audit experience including retail, long-term care, 340B and Medicare Part D pharmacy audits across the 48 contiguous states
  • Pharmacy Benefit Management (PBM) audits
  • Rebate Auditing
  • Fraud, Waste, and Abuse Programs and Investigations
  • Drug utilization analysis and programs designed based on the results
  • Compounding assessments
  • Drug disease management initiatives

SAMPLE PROJECTS

  • A self-insured health plan contracted with IPS to conduct and audit on the pharmacy claims process by their PBM. The audit reviewed up to date pricing, accurate dispensing fees, application of co-payment, compound prescription pricing, and other criteria. IPS evaluated the claims and reported all discrepancies as well as made recommendations for reclaim.
  • A pharmacy data management firm contacted IPS to conduct an audit on manufactures rebates on behalf of a client. IPS identified inconsistencies in rebate payment practices in our audit findings and provided recommendations for reclaim.
  • After a reported controlled substance loss, a hospital contacted IPS to perform routine site inspections, audits and review of all aspects of pharmacy services related to controlled substance management, delivery, administration, record keeping and disposition.
  • A nursing home contacted IPS after the Department of Public Health directed them to engage in an outside independent pharmacy service. IPS performed a full review of all patient profiles and medication orders to ensure accuracy, prepared a report of the findings and provided recommendations for correction.
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